Research over the past 20 years has documented the lack of academic advancement for women, and especially for women of color. Using the Ecological Systems Theory as the theoretical framework, we will identify which factors are associated with academic career advancement, and how these may differ by gender and under-represented minority status. Our specific aims are: 1) To measure longitudinal career outcomes for women compared with men, and under- represented minority women faculty compared with majority women, along the domains of 1) career satisfaction, 2) compensation, 3) academic productivity, 4) academic rank, and 5) retention. 2) To identify how individual (e.g., hours of work, family responsibilities), institutional environment (e.g., support, work environment, policy), and factors that intersect the individual and institutional (e.g., racial discrimination, sexual harassment) are associated with the above career advancement outcomes for women compared with men, and for under-represented minority women compared with majority women. We propose to conduct a longitudinal follow-up to the National Faculty Survey, with a longitudinal sample of 940 faculty, a nationally representative sample of medical school faculty surveyed in 1995, which specifically oversampled for women and minority faculty. We will conduct a survey to obtain current data on the five aspects of academic advancement, and evaluate differences in longitudinal academic advancement by gender and race/ethnicity in our cohort. We will include questions to address individual and institutional factors associated with academic advancement. We will also conduct key informant interviews with two senior personnel at each of the surveyed medical schools, to obtain insight into what institutional programs and policies support the development of women and minority faculty at that institution. This research will provide important new insights for the advancement of women in academic medicine. This longitudinal study of the individual and institutional factors associated with academic advancement for women and minority women will fill an important gap in the knowledge base needed to plan effective programs to support the academic medical careers of women and minorities. PUBLIC HEALTH RELEVANCE: In order to address the public health needs of our increasingly diverse populations, we will require senior health care leaders to reflect the diversity of our populations, in terms of gender, race and ethnicity. In order to examine the individual and institutional factors associated with the advancement of women and minority women to senior positions in biomedical careers, we propose a 15 year longitudinal study of women and under-represented minority women faculty at a representative sample of 24 U.S. medical schools. Our results will assist policy makers and academic leaders in developing programs and policies that will eliminate inequities in career advancement.